Violence During Pregnancy Increases the Risk of Early
Childhood Mortality

By Tim ParsonsSchool of Public Health

Domestic violence toward mothers during pregnancy
significantly raises the risk of death for their children
during the earliest stages of childhood, according to a
study of families in India conducted by researchers at the
Johns Hopkins Bloomberg
School of Public Health. The risk of death was more
than twice as high during the perinatal period (28 weeks of
pregnancy to the first seven days after birth) and neonatal
period (first month following birth) for children of
mothers who experienced domestic violence during pregnancy
as compared to children of mothers who did not. The study
is published in the August edition of the American
Journal of Public Health.

"Our findings indicate that almost one in five
perinatal and neonatal deaths could be prevented with the
elimination of domestic violence, which compares favorably
with other child survival interventions," said Saifuddin
Ahmed, lead author of the study and an assistant professor
in the
Department of Population and Family Health Sciences at
the Bloomberg School.

The study was conducted using data from two separate
health surveys conducted among men and women living in
Uttar Pradesh, a poor state in northern India with high
levels of both domestic violence within marriage and early
childhood mortality. The men's survey included data related
to incidents of domestic violence; the women's survey
included data on infant and child mortality. From the
surveys, the researchers matched data for 5,553 married
couples and then analyzed the outcomes of 2,199 pregnant
women.

According to the results, nearly 18 percent of the
participants were physically abused by their husbands
during their most recent pregnancy. (In comparison, the
prevalence of domestic violence during pregnancy in the
United States has been estimated at between 4 percent and 8
percent.)

After controlling for sociodemographic and maternal
health factors, the researchers found that the mortality
risk during both the perinatal and neonatal periods more
than doubled for offspring of mothers who experience
domestic violence. However, they did not find any
significant associations between domestic violence and
mortality in later stages of early childhood. According to
the researchers, domestic violence may elevate mortality
risk through direct injury to the fetus during pregnancy,
by negatively affecting the mother's stress and nutritional
levels or by deterring the mother from seeking appropriate
health care.

"Our results underscore the need for public education
and awareness programs in developing countries such as
India that highlight the serious and negative consequences
of domestic violence, not only for women but for their
children as well," said Michael A. Koenig, co-author of the
study and an associate professor in the Bloomberg School's
Department of Population and Family Health Sciences. "The
prevention of domestic violence may be an important, but
largely overlooked, intervention for improving child
survival in such settings."

The study was written by Ahmed, Koenig and Rob
Stephenson, of Emory University. The research was supported
by a grant from the National Institute of Child Health and
Development.